Browsing by Author "Vennema, H."
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- Hepatitis A outbreak disproportionately affecting men who have sex with men (MSM) in the European Union and European Economic Area, June 2016 to May 2017Publication . Ndumbi, P.; Freidl, G.S.; Williams, C.J.; Mårdh, O.; Varela, C.; Avellón, A.; Friesema, I.; Vennema, H.; Beebeejaun, K.; Ngui, S.L.; Edelstein, M.; Smith-Palmer, A.; Murphy, N.; Dean, J.; Faber, M.; Wenzel, J.; Kontio, M.; Müller, L.; Midgley, S.E.; Sundqvist, L.; Ederth, J.L.; Roque-Afonso, A.M.; Couturier, E.; Klamer, S.; Rebolledo, J.; Suin, V.; Aberle, S.W.; Schmid, D.; De Sousa, R.; Augusto, G.F.; Alfonsi, V.; Del Manso, M.; Ciccaglione, A.R.; Mellou, K.; Hadjichristodoulou, C.; Donachie, A.; Borg, M.L.; Sočan, M.; Poljak, M.; Severi, E.; Members Of The European Hepatitis A Outbreak Investigation TeamBetween 1 June 2016 and 31 May 2017, 17 European Union (EU) and European Economic Area countries reported 4,096 cases associated with a multi-country hepatitis A (HA) outbreak. Molecular analysis identified three co-circulating hepatitis A virus (HAV) strains of genotype IA: VRD_521_2016, V16-25801 and RIVM-HAV16-090. We categorised cases as confirmed, probable or possible, according to the EU outbreak case definitions. Confirmed cases were infected with one of the three outbreak strains. We investigated case characteristics and strain-specific risk factors for transmission. A total of 1,400 (34%) cases were confirmed; VRD_521_2016 and RIVM-HAV16-090 accounted for 92% of these. Among confirmed cases with available epidemiological data, 92% (361/393) were unvaccinated, 43% (83/195) travelled to Spain during the incubation period and 84% (565/676) identified as men who have sex with men (MSM). Results depict an HA outbreak of multiple HAV strains, within a cross-European population, that was particularly driven by transmission between non-immune MSM engaging in high-risk sexual behaviour. The most effective preventive measure to curb this outbreak is HAV vaccination of MSM, supplemented by primary prevention campaigns that target the MSM population and promote protective sexual behaviour.
- Improving preparedness to respond to cross-border hepatitis A outbreaks in the European Union/European Economic Area: towards comparable sequencing of hepatitis A virusPublication . Enkirch, T.; Severi, E.; Vennema, H.; Thornton, L.; Dean, J.; Borg, M.L.; Ciccaglione, A.R.; Bruni, R.; Christova, I.; Ngui, S.L.; Balogun, K.; Němeček, V,; Kontio, M; Takács, M; Hettmann, A; Korotinska, R; Löve, A; Avellón, A; Muñoz-Chimeno, M; de Sousa, R; Janta, D; Epštein, J; Klamer, S; Suin, V; Aberle, SW; Holzmann, H; Mellou, K; Ederth, JL; Sundqvist, L; Roque-Afonso, AM; Filipović, SK,; Poljak, M; Vold, L; Stene-Johansen, K; Midgley, S; Fischer, TK; Faber, M; Wenzel, JJ; Takkinen, J; Leitmeyer, KSequence-based typing of hepatitis A virus (HAV) is important for outbreak detection, investigation and surveillance. In 2013, sequencing was central to resolving a large European Union (EU)wide outbreak related to frozen berries. However, as the sequenced HAV genome regions were only partly comparable between countries, results were not always conclusive. Aim: The objective was to gather information on HAV surveillance and sequencing in EU/European Economic Area (EEA) countries to find ways to harmonise their procedures, for improvement of cross-border outbreak responses. Methods: In 2014, the European Centre for Disease Prevention and Control (ECDC) conducted a survey on HAV surveillance practices in EU/EEA countries. The survey enquired whether a referral system for confirming primary diagnostics of hepatitis A existed as well as a central collection/storage of hepatitis A cases’ samples for typing. Questions on HAV sequencing procedures were also asked. Based on the results, an expert 2 www.eurosurveillance.org consultation proposed harmonised procedures for cross-border outbreak response, in particular regarding sequencing. In 2016, a follow-up survey assessed uptake of suggested methods. Results: Of 31 EU/ EEA countries, 23 (2014) and 27 (2016) participated. Numbers of countries with central collection and storage of HAV positive samples and of those performing sequencing increased from 12 to 15 and 12 to 14 respectively in 2016, with all countries typing an overlapping fragment of 218 nt. However, variation existed in the sequenced genomic regions and their lengths. Conclusions: While HAV sequences in EU/EEA countries are comparable for surveillance, collaboration in sharing and comparing these can be further strengthened.
- Usability of the international HAVNet hepatitis A virus database for geographical annotation, backtracing and outbreak detectionPublication . Kroneman, A.; de Sousa, R.; Verhoef, L.; Koopmans, M.P.G.; Vennema, H.; On Behalf Of The HAVNet NetworkBackground:HAVNet is an international laboratory network sharing sequences and corresponding metadata on hepatitis A virus in an online database. Aim: We give an overview of the epidemiological and genetic data and assess the usability of the present dataset for geographical annotation, backtracing and outbreak detection. Methods: A descriptive analysis was performed on the timeliness, completeness, epidemiological data and geographic coverage of the dataset. Length and genomic region of the sequences were reviewed as well as the numerical and geographical distribution of the genotypes. The geographical signal in the sequences was assessed based on a short common nt stretch using a 100% identity analysis. Results: The 9,211 reports were heterogeneous for completeness and timeliness, and for length and genomic region of the sequences. Some parts of the world were not represented by the sequences. Geographical differences in prevalence of HAV genotypes described previously could be confirmed with this dataset and for a third (1,075/3,124) of the included sequences, 100% identity of the short common sequence coincided with an identical country of origin. Conclusion: Analysis of a subset of short, shared sequences indicates that a geographical annotation on the level of individual countries is possible with the HAVNet data. If the current incompleteness and heterogeneity of the data can be improved on, HAVNet could become very useful as a worldwide reference set for geographical annotation and for backtracing and outbreak detection.